Journal Article Annotations
2023, 3rd Quarter
Annotations by Alissa Hutto, MD, Julian Raffoul, MD
This double-blind randomized control study found that for patients with opioid use disorder treated with buprenorphine, trazodone was more effective for improving sleep disturbance than placebo. Sleep quality was assessed by a self-report scale (PSQI) at six weeks of treatment, and the average trazodone dose reached in the study was 101mg (starting at 50mg and patients could self-titrate up to 150mg).
Strength and weaknesses:
The study had an thoughtful design with attention tomany confounding factors including withdrawal symptoms and changes in pain scores during treatment. They did not exclude all substance use (allowed nicotine, and non-high-risk cannabis and alcohol use), which is a strength for real-world application of these results. The structure of the buprenorphine clinic allowed weekly dispensing with patient-directed flexibility. One limitation included the imbalance of biological sex in the study, which only included. However, a bigger weakness was the exclusion of patients on psychotropic medications and/or with a comorbid psychiatric disorder aside from a sleep disorder, and those on psychotropic medications. This exclusion brought the available patient pool down by more than 50% and limits generalizability of the results. Another limitation was the short follow-upperiod, with no evidence that improved sleep can be maintained over the long term.
Despite the narrow range of patients included in this study, the authors demonstrated that trazodone may be effective for sleep in patients with opioid use disorder on buprenorphine and have minimal side effects. The study may also help C-L psychiatrists direct discussions about another trazodone trial for patients who may not have had success with trazodone while on full opioid agonists or on methadone but who are now on buprenorphine.